Mounia Serraj

Askin’s tumor: a case report and literature review

Askin’s tumor is a primitive neuroectodermal tumor developing from the soft tissues of the chest wall. Its diagnosis approach is complex and requires a multidisciplinary team. Given the rarity of this entity, no regimen has been validated in the literature. We report two cases of Askin’s tumor with a major response to polychemotherapy and surgical resection in one case. These cases show that treatment of Askin’s tumor should be multimodal, requiring discussion in multidisciplinary tumor working groups.

Aspergilloma in combination with adenocarcinoma of the lung.

A 60 year old male with a long standing history of smoking was referred to our department for surgery of aspergilloma in right upper lung lobe diagnosed by computed tomography and confirmed by computed tomography guided needle aspiration biopsy. A lobectomy was performed. Histological study of the surgical specimen revealed a pulmonary adenocarcinoma associated with aspergilloma. By presenting this case we suggest that every case of pulmonary aspergillome should be examined for malignancies, especially in smokers.

Pseudotumoral tracheobronchial amyloidosis mimicking asthma: a case report

IntroductionTracheobronchial amyloidosis is an uncommon localized form of amyloidosis that can simulate a tracheal tumor. Clinical signs are not specific and the diagnosis is rarely given before performing a bronchoscopy with multiples biopsies.Case presentationWe report the case of a 60-year-old Moroccan woman, complaining of dyspnea and wheezing for three years, who was treated at our institution for management of severe asthma. A bronchoscopy revealed a tumor formation of her trachea; multiples biopsies were performed and a diagnosis made of amyloid light-chain amyloidosis. She successfully received an endoscopic resection.ConclusionThis case highlights the importance of routinely carrying out an endoscopy in any patient complaining of atypical bronchial symptoms or with uncontrolled asthma. Tracheal amyloidosis is a rare disease, confirmed by histological examination of bronchial biopsies, and the treatment of choice is based on the bronchoscopic resection.

The diagnostic value of the bronchoalveolar lavage in interstitial lung diseases

ObjectiveBronchoalveolar lavage (BAL) is a diagnostic tool often used during the management of interstitial lung diseases (ILD). However, its diagnostic value in discrimination between entities comprising the very heterogenous group of ILD, is still a controversial issue. The objective of our study is to assess the diagnostic value of BAL in the management of ILD, by comparing the cytological findings in BAL fluid among the different diseases of this group.MethodsIt was a retrospective, observational study of 151 patients between January 2012 and December 2015. BAL fluid cytology was performed to analyse the distribution of leucocytes population subsets in patients with ILD.ResultsThe mean age was 52.78xa0years; 74.83% were women. The analysis of the following main groups of diseases was performed : sarcoïdosis (nu2009=u200930), idiopathic pulmonary fibrosis (IPF; nu2009=u200922), other idiopathic interstitial pneumonia (non specific interstitial pneumonia, cryptogenic organising pneumonia and respiratory bronchiolitis interstitial lung disease; nu2009=u200920) and connective tissue disease (nu2009=u200914).Overall, out of 141 patients, 22% had sarcoïdosis, 15.6% had idiopathic pulmonary fibrosis (IPF), 14.18% had other idiopathic interstitial pneumonia (IIP) and 9.9% had connective tissue disease (CTD). Mixed alveolitis was common in the 4 groups, sarcoïdosis had higher proportion of lymphocytes and IPF had higher neutrophils count. However, there was no significant statistical difference of BAL cellular count among these diseases (pu2009>u20090.05). Also, the prevalence of studied diseases did not change with variation of BAL cellular count (pu2009>u20090.05).ConclusionAlone, the BAL cytological analysis has a limited value to provide substantial information that could lead to discriminate between diseases that form ILD. Thus, it must be always associated with other diagnostic methods.

About a submucosal tracheal tumor

The authors report the case of 46-year-old man with recurrent hemoptysis. Bronchoscopy revealed a submucosal tumor protruding into the tracheal lumen. Transbronchial biopsy failed to obtain a conclusive diagnosis; only surgery allowed complete resection of the tumor and confirmed the diagnosis of tracheal mucoepidermoid carcinoma. We discuss the unusual submucosal presentation of this tumor, and the contribution of surgery for diagnosis and therapy.

La prévalence de la somnolence diurne excessive et ses facteurs déterminants chez les travailleurs d’un centre d’appel à Fès

Objectif L’ampleur de la somnolence diurne excessive (SDE) reste meconnue au Maroc. Cette etude a comme objectifs d’evaluer la prevalence de la SDE, ses facteurs determinants et repercussions sur le rendement chez les travailleurs d’un centre d’appel de Fes. Methodes Il s’agit d’une etude transversale a visee descriptive et analytique concernant 322xa0travailleurs d’âge moyen de 27,9xa0ans et comprenant un auto-questionnaire sur les troubles du sommeil et les conditions de travail avec les echelles Epworth (en arabe marocaine), de fatigue Pichot, d’anxiete depression HAD, et de Berlin. Resultats La prevalence de la SDE selon l’echelle d’Epworth est de 19,3xa0%. L’analyse bivariee montre que la prevalence de la SDE est plus elevee (entre 24,9xa0% et 56,2xa0%) en cas dexa0: debut du travail avant 8xa0h AM, difficulte a rester attentif, fatigue au travail, le bruit monotone, conditions de travail degradees, rendement insatisfaisant, de vie familiale degradee, un score anxiete eleve, un score de depression eleve, ou un score de Pichot≥22 (34,6xa0%). On trouve une SDE nettement plus elevee chez les ronfleurs 39,4xa0% et ceux avec un score de Berlin positif 42,9xa0%. L’analyse multi variee montre que les principaux facteurs de risque impliques dans la SDE sont les conditions de travail notamment la difficulte a rester attentif ORxa0=xa03,39xa0et la fatigue au travail ORxa0=xa09,82. Les travailleurs les moins somnolents ont un rendement superieur aux attentes ORxa0=xa00,35. Conclusion Notre etude souligne la prevalence tres elevee de la SDE chez les travailleurs du centre d’appel avec comme facteur determinant principal les conditions de travail.

La prévalence de la somnolence diurne excessive et sa relation avec le travail posté chez le personnel soignant du CHU Hassan II de Fès

Objectif Cette etude a comme objectifs d’evaluer la prevalence de la SDE, ses facteurs determinants, evaluer le role du travail poste, et l’impact de la SDE sur le rendement. Methodes Il s’agit d’une etude transversale a visee descriptive et analytique concernant 300xa0travailleurs d’âge moyen de 28xa0ans (23–46xa0ans) et comprenant un auto-questionnaire sur les troubles du sommeil et les conditions de travail avec les echelles Epworth (version arabe marocaine), et de Berlin. Le taux de participation totale de 100xa0%. Parmi le personnel, 64,7xa0% sont des travailleurs postes. Resultats La prevalence de la SDE est de 30xa0%. L’analyse bivariee montre une prevalence de SDE significativement plus elevee en cas dexa0: âgexa0>xa030xa0ans (52,4xa0%), duree de sommeil xa048xa0h (35,2xa0%), repetition des actes dans le travail (39,5xa0%), necessite d’attention (37,5xa0%), bruit monotone (38,9xa0%), ronflement (46,4xa0%), score de Berlin positif (82,6xa0%) et conditions de travail degradees (43,5xa0%). La SDE est significativement plus elevee en cas de rendement insatisfaisant (60xa0%) et de vie affective et familiale degradee (43,5xa0%). L’analyse multivariee montre que les principales etiologies de la SDE sont le ronflement (ORxa0=xa02,63), la forte probabilite du SAOS selon le Berlin (ORxa0=xa05,36) et le travail poste (ORxa0=xa01,24). Elle a montre aussi que la SDE est un facteur determinant dans le rendement insatisfaisant (ORxa0=xa03,16). Conclusion Notre etude souligne la prevalence tres elevee de la SDE chez personnel medical et paramedical de notre CHU et le role determinant du travail poste et des troubles respiratoires du sommeil et les repercussions sur le rendement.

Unexpected pulmonary tumor: metastasis from a benign uterine leiomyoma in a post-menopausal woman: a case report

BackgroundThe occurrence of lung metastasis from benign uterine leiomyomas is rarely reported especially in post menopausal women. The pathogenesis of these metastatic benign tumors still remains a subject of various speculations.Case presentationA 57-year-old woman presented with a chronic cough and dyspnea. She had undergone 8xa0years previously, hysterectomy for benign leiomyomas. A chest computed tomography scan showed a 4xa0cm solitary nodular parenchymal tumor that increased in size after 12xa0months. The histological analysis of the biopsy from this nodule showed a benign tumor with regular spindle cells disposed in intersected fascicles. At immunohistochemical analysis, the tumor cells were positive for smooth muscle markers and oestrogen-progesterone receptors with a low mitotic index assessed by Ki-67. These features were consistent with a benign metastasizing uterine leiomyoma. At the multidisciplinary meeting, prescription of an aromatase inhibitor has been decided for the patient.ConclusionsBenign metastasizing uterine leiomyomas of the lung are very rare tumors. Although extremely rare in post menopausal women, their diagnosis should be considered in symptomatic patients with a history of hysterectomy for leiomyomas.

Observance à la ventilation en pression positive continue (PPC) : étude à propos de 50 patients

Objectif Nous proposons une etude evaluant l’observance a moyenne terme du traitement par l’auto-PPC chez 50xa0malades suivis pour SAOS en unite de sommeil au service de pneumologie au CHU Hassan II de Fes. Methodes Nous avons evalue les donnees cliniques et les donnees des rapports d’observance enregistrees dans les appareils de PPC durant les differentes consultations de suivi. Resultats La periode de suivi allant de 2xa0mois a 16xa0mois depuis janvier 2013. La moyenne d’âge est de 50xa0ans, le sex-ratio 26H/24F. La valeur moyenne de l’IMC est 32. Le diagnostic de SAOS est confirme par polysomnographie, la valeur moyenne de l’index apnee-hypopnee (IAH) initial est 54. Le mode auto-PPC est utilise chez 94xa0% des patients. Les moyennes de la pression minimale et maximale utilisees sont respectivement 8xa0et 14xa0cmH2. Les rapports d’observance des appareils de PPC montrent quexa0: la moyenne de la duree d’utilisation est de 6xa0hxa0±xa02xa0h, la moyenne du pourcentage des jours d’utilisationxa0>xa04xa0h est de 82xa0%, la moyenne de la pression moyenne de l’appareilxa0 Conclusion Nous insistons sur les bons resultats d’observance dans notre etude et nous analysons les facteurs susceptibles de l’ameliorer.